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Question:

From Virginia, USA:

My son is 14. He was diagnosed at age 11. He weighs about 140 lbs and is 5 feet, 9 inches. I think he is not overweight, just growing. We have been increasing the insulin, where he now takes 52 units of Lente in the morning. Even then, before dinner sugars are generally in the 200-250 range. Our target is to get the sugars between 100 and 200. Is there some mix of insulins that would be effective at certain times? I think he needs more in the afternoon and evening hours because that's when he takes in most of the calories. So far, he mixes Lente and Regular.

Answer:

There is no one "mix" of insulin that works for everyone. If one regimen doesn't work, you have to try another. You only mention that your son takes 52 Units of Lente in the AM [and is on two shots a day]. Without knowing the details, this sounds like a lot of Lente in the AM for his size. You should keep in mind that as you increase the dose of any insulin, it lasts longer. Sometimes if you increase the AM Lente to try and decrease the blood sugar before supper (which is what is usually recommended), the blood sugar doesn't improve at supper, but may go lower later in the evening or the next morning. Sometimes it is the morning Regular that needs to be increased to improve the blood sugar before supper. (If you increase the morning Regular, you may need to decrease the AM Lente and increase the PM Lente if the blood sugar increases before breakfast.)

I usually recommend to patients when they make a change in an insulin dose to try and predict which blood sugar during the day will change when they change a particular insulin, and then actually check to see if this prediction is correct, or if a blood sugar earlier or later during the day changes instead. This may indicate that the insulin is working faster or lasting longer than "average."

If he is unable to control his blood sugar on 2 shots a day, he may want to discuss with his physician taking 3 shots a day if he's son is willing. Keep in mind, that your son's insulin requirements may change frequently during this period of rapid growth.

TGL

Original posting 9 Feb 97

  
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Last Updated: Tuesday April 06, 2010 15:08:54
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